# EDGEWOOD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1801056395
- **Authorized official:** CHRISTOPHER TYRONE TATUM (COUNSELOR)
- **Authorized official phone:** (451) 845-5073

## Contact information

- **Practice address:** 1801 VICENTE ST, SAN FRANCISCO, CA 94116-2923
- **Practice address phone:** (415) 681-3211
- **Practice address fax:** (415) 375-7670
- **Mailing address:** 1801 VICENTE ST, SAN FRANCISCO, CA 94116-2923
- **Mailing address phone:** (415) 681-3211
- **Mailing address fax:** (415) 375-7670

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | 101Y00000X | CA | Yes |

## Other

- **Enumeration date:** 06/10/2008
- **Last updated:** 06/10/2008